Medical and personal hygiene procedures

Standard Infection Control Procedures and First Aid

It is important that basic hygiene and precautions for first aid procedures are applied in all schools. Standard precautions, if properly implemented, minimise the risk of transmission of infectious diseases including bacterial and viral infections.

There is no scientific reason for any teacher, school assistant or other employee to refuse first aid or medical assistance to any student or adult provided the following hygiene rules are adhered to. The role of the first aid officer is important in this procedure.

Procedures

Principals are to:

ensure that the workplace has its first aid kit properly stocked and routinely checked every six months to ensure all products comply with appropriate storage and use-by requirements
remind staff of the need for care in dealing with blood/body fluids and cases of external bleeding. Appropriate training should be given to all staff
have in place an Action Plan for checking school grounds for syringes and/or needles, and on excursions checking, for example, known areas for syringe and needle disposal (eg parks, public toilets, beaches).

A "Sharps Discovery Report Form" must be completed and returned to the Coordinator, Needle and Syringe Exchange program, Sexual Health Unit, Department of Health and Human Services (DHHS) whenever a syringe or needle is found on school grounds. A copy of the report is to be sent to the Learning Service and kept on the school records.

Equipment and qualified personnel

Principals should ensure that the school's first aid kit is easily accessible. There should be more than one kit in larger schools, or in schools with isolated buildings.

It is also recommended that smaller emergency kits be located at various sites around the school. These kits are not designed to cater for minor injuries, but are for emergency situations such as dealing with a non-breathing student, or with severe bleeding. A small kit may be carried by playground duty teachers, particularly where grounds are large.

It is recommended that all schools have a first aid officer on site at all times for duty to employees and students. An allowance is available to First Aid Officers.

The maximum number of allowances payable at each worksite is:

Up to 350 students one appointment
351-849 students and/or special schools two appointments
850 students and above three appointments

Schools should ensure back-up personnel are available when designated first aiders are not available.

Standard infection control precautions

Basic hygiene and standard precautions should be applied in all schools in all situations, regardless of any assessment of risk.

The key to the success of standard precautions is that they apply to everyone in the school environment. Application of the same precautions to all individuals and situations provides protection to the caregiver and removes the potential for actions to be seen as discriminatory.

Precautions should be regarded as good hygiene practices and routinely adhered to as the basic level of infection control.

They include:

routinely wash hands using soap and running water (including before and after the routine use of gloves)
use single-use cake soap or pump action soap containers for washing hands before and after first aid procedures. Adults need to administer pump soap so as not to contaminate surfaces
wet wipes can be used to remove small amounts of blood from children in classrooms without sinks eg minor cut to a finger. However any material with body fluid waste including blood must be disposed of into a plastic garbage bag and sealed for disposal.
use protective barriers such as disposable gloves when dealing with blood/body fluids
appropriate disposal of soiled material and needles/syringes, and
the cleaning of surfaces that have been in contact with bodily fluids.

Blood and other body fluids

The following routine precautions should be observed when assisting any student or staff member who has sustained a cut or similar injury involving a blood spill or when dealing with any other body fluid/substance such as vomit, saliva, urine and faeces:

first aid kits should include appropriate antiseptics, disposable gloves (available from State Purchasing and Sales), and disposable Expired Air Resuscitation (EAR) face masks for resuscitation
use disposable gloves when handling blood or other body fluids. Thoroughly wash lower arms and any other parts of the body in contact with or splashed by blood or fluids. After removing gloves, thoroughly wash hands. Use soap and running water when washing
remove the bulk of the material from benches or other blood or body fluid-soiled areas with paper towels. Wipe down with warm, not hot, water and detergent. This is appropriate for surfaces such as change tables and desks where students’ skin comes into direct contact with the surface, and for porous items eg wood
use paper towels to remove blood from carpets. Wash carpeted areas with detergent and water, and arrange for steam cleaning
place wastes (including gloves) after contact with blood or body fluids in a plastic bag and seal for disposal or incineration
thoroughly wash scissors or other instruments (Stanley knives, chisels etc) in warm water and detergent to remove any blood. Wear heavy-duty rubber gloves to ensure no further injury is sustained. For items to be used again relatively soon, wipe instrument with a disinfectant solution (such as MiltonTM or use IsowipesTM or Pro-wipesTM) and dry
students who have a nosebleed should be encouraged to treat themselves. For example be given instructions to sit still and pinch the bridge of their nose
do not send students who are bleeding to the toilets to clean themselves up or send them to the first aid area alone. They must not be allowed to touch door handles or any equipment etc while they have blood on their hands.
have a back tracking system for nosebleeds or any other blood spill situation to ensure no blood is left on the ground. Blood spills in sandpits, on grass, asphalt, gravel ought to be well hosed
encourage students to wash hands after treatment has been completed
carefully check students who have been involved in fights to ensure there has been no potential transfer of blood
the "blood" rule in sport needs to be applied in all schools.

If possible, students and staff should be taught to provide the appropriate equipment for any bleeding (conscious) person to deal with their own bleeding until a trained person arrives.

When students have gone to the assistance of a bleeding child, they too should thoroughly wash their hands, lower arms and any other body parts that have been in contact with blood. Use soap and running water when washing. Skin-to-skin contact should be avoided, as should contact with blood-spotted clothes. In some circumstances it may be appropriate to hold a change of clothing at school. Parents should be informed if their child has been involved with another bleeding child and advised to contact their medical practitioner for further advice.

The Australian National Council on AIDS has produced an Infection Control in the Health Care Setting book which may be a useful reference for schools. It is available through the Australian Government Information Shop, Criterion St, Hobart, phone (03) 6234 1403.

School laboratory procedures for blood grouping

The National Blood Transfusion committee has banned the use of human source reagents for blood group testing because of the potential risks of transmission of infections such as HIV and Hepatitis B and C.

Non-human source grouping reagents theoretically are now available, however schools should still not be involved in activities such as blood group testing due to the risk involved to students.

Discarded needles/syringes

It is possible that a student or staff member may find a syringe in a school playground. Students should be encouraged to immediately inform a teacher or cleaner, and under no circumstances to pick up the syringe.

These procedures should be followed by the staff removing the syringe:

wear disposable latex gloves
clear the area of students. Be aware that there may be other needles/syringes in the area
do not try to recap the needle
using forceps or tongs pick up the needle/syringe and place into approved "sharps" disposal container. Place syringe, needle point down, in the disposal container
remove gloves and dispose of appropriately
wash hands well with soap under running warm water.

Syringe disposal containers or syringes must not be put in normal school rubbish bins. Contact local Community Health Centre or Sexual Health Unit, Tasmanian Department of Health and Human Services, for advice on correct disposal. Other sources of assistance are Environmental Health Officers at the local council, and the police, as all patrol cars are now fitted with sharps disposal units.

Condoms

It is also possible that a used condom could be found in a school playground. Students should not touch the condom. They should immediately inform a teacher or cleaner.

The teacher/cleaner should dispose of the condom in an appropriate manner using rubber gloves.

Exposure to blood or body fluids - including needlestick injury

A significant exposure to blood or body fluids may include :

penetrating injury eg needlestick
blood or body fluid splash onto non-intact skin
blood or body fluid splash into mucous membrane such as eyes or mouth.

First aid for needle stick injury:

wear disposable gloves
remove needle/syringe, ensuring plunger is not depressed in any way
place needle/syringe in an approved "sharps" container. Retain the syringe as it may be needed for testing
wash the area well with soap and water and apply an antiseptic (if available).

For blood/body fluids onto skin:

irrespective of whether there are cuts or abrasions, wash well with soap and water
For blood/body fluids into eyes:
rinse the eyes gently but thoroughly with large volumes of water or normal saline while the eyes are open

For blood/body fluids into mouth:

spit, and then rinse the mouth with water several times.

Other standard procedures include:

report the accident/injury to the school principal
if the injury occurs to a pupil, parents should be contacted
a medical officer should be consulted as soon as possible
depending on the circumstances of the exposure, the following may be considered:
- Tetanus immunoglobulin
- a course of adult absorbed diphtheria tetanus vaccine - adult formulation (Td) vaccine; or
- Td booster

in addition, the exposed person would normally be tested for HIV, Hepatitis B and C. Expert counselling on the implications of the event, post-exposure prophylaxis and appropriate long-term follow-up should be offered.

Sandpits

Sandpits in playgrounds need to be kept covered to minimise the risk of bacterial infection, especially those associated with animal excreta such as toxoplasmosis. Also "sharps" such as needles may be planted in sandpits.

Specific risks

Body piercing, including ear piercing, undertaken during school activities should be prohibited. Students attending school camps, where piercing activities sometimes occur, should be warned of the risks.

Librarians and literature teachers should be alert to the inclusion in some novels of the practice of blood brothers/sisters rituals which are sometimes described in detail. Students need to be made aware of the inherent risks.

Self tattooing/scarring - the area/scars need to be appropriately covered.

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